Children’s Hospital Oakland

Date

Drug

Administration Time

Dose     or      freq

CHOOSE ONE

Crying/agitated 25-50 %

Crying/agitated ≥50 interval

2

3

CHOOSE ONE:

Sleeps <25% of interval

Sleeps 26% to 75% of interval

Sleeps >25% of interval

3

2

1

CHOOSE ONE:

Hyperactive Moro

Markedly hyperactive Moro

2

3

CHOOSE ONE:

Mild Tremors, disturbed

Moderate/severe tremors, disturbed

1

2

Increased muscle tone

2

Temperature 32.2-38.4°C

1

Temperature  >38°

2

Respiratory rate >60 (extubated)

2

Suction >twice/ Interval (Intubated)

2

Sweating

1

Frequent yawning  (>3-4/Interval

1

Sneezing (>3-4/interval)

1

Nasal stuffiness

1

Emesis

2

Projectile vomiting

3

Loose stools

2

Watery stools

3

TOTAL SCORE

ADJUSTED SCORE

INITIALS Of PERSON SCORING